MEDICARE: BREANA CLINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	012941-01	NY

General Provider Information

NPI Number	:	1396342044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANA CLINE

Provider Business Mailing Address
First Line	:	1994 NEW ST
Second Line	:
City	:	ONTARIO
State	:	NY
Zip	:	14519-8806
Country	:	US
Telephone Number	:	315-879-7304
Fax Number	:

Provider Business Practice Location Address
First Line	:	1994 NEW ST
Second Line	:
City	:	ONTARIO
State	:	NY
Zip	:	14519-8806
Country	:	US
Telephone Number	:	315-522-0953
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	07/23/2024

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Directions to “ BREANA CLINE ” Practice Location

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